Apparatus and method for joint repair

ABSTRACT

A bolster system having a first bolster device, a second bolster device, and an adjustable tether that includes a one-way pre-tied slideable adjustment knot. The adjustment knot is at a first position prior to insertion of the first bolster device into a passageway in one or more bones. The second bolster device includes a body portion having an outer portion that is sized to be received in the passageway and/or in an aperture of a bone plate. The body portion also includes a channel that is sized to accommodate recessed and/or embedded placement of the pre-tied slideable adjustment knot. The second bolster device can also include an oversized plate portion that abuts against a cortex of a bone or a wall of a bone plate. The second bolster device can also include a threaded member or retention tab that lockingly secures the second bolster device to a bone plate.

BACKGROUND

Embodiments of the present invention generally relate to joint repair.More particularly, but not exclusively, embodiments of the presentinvention relate to an adjustable apparatus that at least assists inmaintaining tension on a one or more bones during joint repair and/orhealing.

Reconstructive surgery can be utilized to repair damaged and/or unstablesprains, among other injuries. For example, in at least certaininstances, reconstructive surgery can be utilized to repair damage tothe distal tibiofibular joint, including but not limited to damageassociated with certain high ankle sprains and/or breaks and fracturesof the fibula and tibia, among repairs to other joints. Such surgeriescan seek to establish/re-establish the correct apposition, placement,and/or separation of the fibula relative to the tibia, or vice versa.Further, such reconstructive surgery can also seek to re-establish theintegrity of the fibula and tibia, as well as re-establish axial,rotational and transitional forces. A common procedure for repairingcertain types of injuries to the distal tibiofibular joint is syndemosisscrew fixation. During syndemosis screw fixation, at least two fixationscrews are driven into drilled holes in the bone(s) of a patient. Suchscrews are typically also driven through holes in a bone plate thatabuts, or is generally positioned adjacent to, an outer surface of thepatient's bone. Yet, such drilling and screw implantation can causedamage to the bone(s) and/or weaken portions of the bone. Further, afterseveral weeks or months of recovery, such hardware is typically removedfrom the patient, which typically involves the patient undergoing asubsequent or additional procedure.

SUMMARY

Certain embodiments of the present invention provide an apparatus thatincludes an adjustable tether having a pre-tied knot slideablydisplaceable in one direction from a first axial position to a secondaxial position. The apparatus also includes a first bolster device thatis coupled to the adjustable tether, the first bolster device having awidth and a length that are each sized to accommodate passage of thefirst bolster device through a passageway in a first orientation of thefirst bolster device, and which are sized to prevent passage through thepassageway when the first bolster device is in a second orientation.Further, the pre-tied knot is tied prior to insertion of the firstbolster device into the passageway. The apparatus also includes a secondbolster device coupled to the adjustable tether, the second bolsterdevice being positioned between the pre-tied knot and the first bolsterdevice. The second bolster device includes a channel that extendsthrough at least a portion of the second bolster device, the channelbeing sized to receive replacement of the pre-tied knot. Further, anaxial distance between the pre-tied knot and the first bolster device isreduced by slideable displacement of the pre-tied knot from the firstaxial position to the second axial position.

Additionally, certain embodiments of the present invention provide anapparatus comprising a first bolster device and a second bolster device,the second bolster device having a plate portion and a body portion, thebody portion including a channel that extends through the plate portion.The apparatus can further include an adjustable tether that extendsthrough one or more apertures of the first bolster device and the bodyportion of the second bolster device. The adjustable tether includes apre-tied slideable locking knot that is embedded within the secondbolster device. The pre-tied slideable locking knot is displaceable fromat least a first position to a second position along the adjustabletether. Additionally, the adjustable tether can have a first lengthbetween the first and second bolster devices when the pre-tied slideablelocking knot is at the first position and a second length when thepre-tied slideable locking knot is at the second position, the secondlength being smaller than the first length. Additionally, the pre-tiedslideable locking knot is at the first position prior to insertion ofthe first bolster device into the formed passageway.

Further, certain embodiments include is a method that includes forming,with at least a drill bit, a passageway through one or more bones anddisconnecting the drill bit from a drill. Further, a lead suture iscoupled to the disconnected drill bit, the lead suture also beingcoupled to a first bolster device that is coupled to a second bolsterdevice by an adjustable tether that has a pre-tied knot that is embeddedat a first position along the adjustable tether within the secondbolster device. The lead suture and the first bolster device aredisplaced through the passageway, via displacement of the drill bit.After displacing the first bolster device through the passageway, thepre-tied knot is slid along the adjustable tether from the firstposition to a second position, with a length of the adjustable tetherbetween the first bolster device and the pre-tied knot being reduced asthe pre-tied knot is slid from the position to the second position.

BRIEF DESCRIPTION OF THE DRAWINGS

The description herein makes reference to the accompanying figureswherein like reference numerals refer to like parts throughout theseveral views.

FIG. 1A illustrates a side perspective view of a portion of a bolstersystem that is coupled to a lead suture.

FIG. 1B illustrates a side perspective view of a bolster system that iscoupled to a lead suture and which includes an adjustable tether havinga pre-tied slideable locking knot.

FIG. 2 illustrates a side perspective view of a bolster system.

FIGS. 3A and 3B illustrate a front view and a side cross-sectional view,respectively, of an exemplary embodiment of a first bolster device.

FIGS. 4A and 4B illustrate a front view and a top perspective view,respectively, of an exemplary embodiment of a second bolster device.

FIGS. 5A-5C illustrate a front view, a top view, and a sidecross-sectional view, respectively, of an exemplary embodiment of asecond bolster device.

FIGS. 6A and 6B illustrate a front view and top view, respectively, ofan exemplary embodiment of a second bolster device.

FIG. 6C illustrates a cross-sectional view of an embodiment of a secondbolster device taken along line 6C-6C of FIG. 6B.

FIG. 6D illustrates a cross-sectional view of an exemplary embodiment ofa second bolster device taken along line 6D-6D of FIG. 6B.

FIG. 7A illustrates a side view of an exemplary embodiment of a secondbolster device having a retention tab.

FIGS. 7B and 7C illustrate a top view and a bottom view, respectively,of the second bolster device shown in FIG. 7A.

FIG. 8 illustrates a side view of an exemplary embodiment of a secondbolster device having a threaded member.

FIG. 9 illustrates a side view of a bolster system that includes thesecond bolster device from FIGS. 6A and 6B.

FIGS. 10A and 10B illustrate an outer side perspective view and a rearside view, respectively, of an exemplary bone plate for use with abolster system of the present invention.

FIG. 11 illustrates an exemplary drill bit configured for use with abolster system of the present invention.

FIG. 12 illustrates use of an exemplary drill guide to guide thelocation and trajectory of drilling by a drill bit through one or morebones in connection with forming a passageway through the bone(s).

FIG. 13A illustrates a perspective view of an exemplary first drill bitthat can provide a guide for a second drill bit in connection withshaping a cross-sectional shape and/or size of a passageway in one ormore bones.

FIG. 13B illustrates a second drill bit positioned along a slot of thefirst drill bit of FIG. 13A as the second drill bit is removing bonematerial in connection with shaping a passageway in one or more bones.

FIG. 14A illustrates a side perspective view of an exemplary shapingapparatus structured to form a cross-sectional shape and/or size of apassageway in one or more bones.

FIG. 14B illustrates an example of the shaping apparatus shown in FIG.14A being inserted into a bone of a patient.

FIG. 15A illustrates an example of a lead suture that is coupled to abolster system being pulled through a passageway in one or more bones.

FIG. 15B illustrates an example of a bolster system that is operablypositioned to maintain tension on a tibia and femoral bone in connectionwith syndemosis joint repair.

FIG. 15C illustrates a second bolster device engaged with an exemplarydriver as the second bolster device is being displaced into engagementwith an exemplary bone plate.

FIG. 15D illustrates a side view of an embodiment of a driver configuredfor driving engagement with a second bolster device.

FIGS. 16A and 16B illustrate an anterior view and a posterior view,respectively, of a bolster system operably extending through adjacentmetacarpal bones.

FIG. 16C illustrates a phantom medial view of the bolster system andmetacarpal bones shown in FIGS. 16A and 16B.

FIGS. 17A and 17B illustrate a side view and a phantom side view,respectively, of a bolster system used in connection with repairs to anacromioclavicular joint.

The foregoing summary, as well as the following detailed description ofcertain embodiments of the present invention, will be better understoodwhen read in conjunction with the appended drawings. For the purpose ofillustrating the invention, there is shown in the drawings certainembodiments. It should be understood, however, that the presentinvention is not limited to the arrangements and instrumentalities shownin the attached drawings.

DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS

Certain terminology is used in the foregoing description for convenienceand is not intended to be limiting. Words such as “upper,” “lower,”“top,” “bottom,” “first,” and “second” designate directions in thedrawings to which reference is made. This terminology includes the wordsspecifically noted above, derivatives thereof, and the words of similarimport. Additionally, the words “a” and “one” are defined as includingone or more of the referenced item unless specifically noted. The phrase“at least one of” followed by a list of two or more items, such as “A, Bor C,” means any individual one of A, B or C, as well as any combinationthereof.

FIGS. 1A, 1B, and 2 illustrate side perspective views of at least aportion of a bolster system 100 according to an embodiment of thepresent invention. As illustrated, the bolster system 100 can include afirst bolster device 102, a second bolster device 104, and an adjustabletether 106. FIGS. 1A, 1B, and 2 further depict a lead suture 108 coupledto the first bolster device 102. The first and second bolster devices102, 104 can be constructed from a variety of different materialsincluding, for example, stainless steel, plastic and titanium, amongother suitable materials. As discussed below in greater detail, theadjustable tether 106 can comprise a wire, fiber or suture 110, amongother items or devices, that passes around, through, and/or about atleast a portion of the first and second bolster devices 102, 104 so asform an adjustable tether 106 therebetween that is operably coupled tothe first and second bolster devices 102, 104. Further, as shown in atleast FIGS. 1B and 2, the first bolster device 102 can be positioned ata first end 112 of the adjustable tether 106, while the second bolsterdevice 104 can be positioned at or around a second, opposite end 114 ofthe adjustable tether 106.

As illustrated in at least FIG. 1B, and as discussed below in greaterdetail, the adjustable tether 106 can include a pre-tied slideablelocking knot 116 at or around the second end 114 of the adjustabletether 106. Moreover, according to the illustrated embodiment, theslideable locking knot 116 can be positioned at an end of the tether 106adjacent to the second bolster device 104. The pre-tied slideablelocking knot 116 can be structured for use in adjusting a length of theadjustable tether 106 between the first and second bolster devices 102,104 and/or to secure relative positions of the first and second bolsterdevices 102, 104 so that the bolster system 100 at least providestension on a fibula and tibia bones 128 a, 128 b (FIG. 15B). Further,according to certain embodiments, the slideable locking knot 116 can bea one-way locking knot, and more specifically a knot that can shorten,but not expand, at least the distance of the locking knot 116 from thefirst bolster device 102 relative to the adjustable tether 106. Avariety of different types of knots can be used as the pre-tiedslideable locking knot 116 including, but not limited to, a woven, fastfix, square, and cow hitch knot, among other suitable types and stylesof knots.

As illustrated in FIG. 1B, according to certain embodiments, thepre-tied slideable locking knot 116 can comprise lockingly intertwinedportions of one or more sutures 110 of the adjustable tether 106 thatextend away from the second bolster device 104. Further, according tothe illustrated embodiment, the pre-tied slideable locking knot 116 isformed prior to implantation of at least a portion of the bolster system100 into one or more bones of a patient. For example, FIG. 1B providesan indication of the routing of portions of the suture 110 about itselfor other sutures 110 in a manner that can form the pre-tied slideablelocking knot 116 prior to implantation of the bolster system 100 into apatient. Additionally, as discussed below, the pre-tied slideablelocking knot 116 can be formed in a manner that allows the pre-tiedslideable locking knot 116 to be displaced along at least a portion ofthe adjustable tether 106, at least after a portion of the bolstersystem 100 has routed through a passageway in a bone 128 a, 128 b of apatient in a manner that can facilitate or enhance the ability of thebolster system 100 to exert compressive tension against one or more ofthe patient's bones 128 a, 128 b.

Additionally, according to certain embodiments, the tether 106 canextend from the second bolster device 106 to first bolster device 102,where a portion of the tether 106 can wrap or extend around a portion ofthe first bolster device 102, and return to the second bolster device104, where a portion of the tether 106 can wrap or extend around aportion of the second bolster device 104. According to certainembodiments, this process can be repeated one or more additional timesin a manner that accommodates multiple portions or loops of the tether106 being wound and/or extending between the first and second bolsterdevices 102, 104. Further, opposing ends of the tether 106 can extendfrom the second bolster device 104 such that at least a portion of thetether 106 forms the slideable locking knot 116.

FIGS. 3A and 3B illustrate front and side cross-sectional views,respectively, of an exemplary embodiment of a first bolster device 102.As illustrated, the first bolster device 102 can include a body portion118 that extends between first and second ends 120, 122 along a centralaxis 124. Further, according to the illustrated embodiment, the firstbolster device 102 can have a first length or height in a direction thatis relatively or generally parallel to the central axis 124 (asindicated by the “L₁” direction in FIG. 3A) that is longer than a secondlength or width of the first bolster device 102 in a direction that isarranged generally perpendicular to the central axis 124 (as indicatedby the “L₂” direction in FIG. 3B). For example, according to certainembodiments, the first bolster device 102 can have a variety of shapesincluding, for example, rectangular, trapezoidal, oval, or triangular,among other suitable shapes and sizes. As discussed below in greaterdetail, according to certain embodiments, such a configuration canpermit the first bolster device 102 to be manipulated to a firstorientation in which the first bolster device 102 can pass through apassageway 126 in one or more bones 128 a, 128 b (FIGS. 15A and 15B)that has a size that is similar or greater than the second length orwidth of the first bolster device 102, but which is less than the firstlength of the first bolster device 102. Upon removal from the passageway126, the first bolster device 102 can be placed in a second orientationin which the first bolster device 102 is positioned in a manner thatutilizes the larger first length of the first bolster device 102 toprevent re-entry of the first bolster device 102 into the passageway126.

According to the illustrated embodiment, the first bolster device 102includes one or more tether apertures 130 a, 130 b that extend betweenthe front side 131 a and the back side 131 b of the first bolster device102 along an aperture axis 133 that can be arranged generallyperpendicular to the central axis 124 of the first bolster device 102.The tether apertures 130 a, 130 b are sized to at least received one ormore passages of portions of the suture(s) 110 of the adjustable tether106. For example, according to the illustrated embodiment, the firstbolster device 102 includes a first tether aperture 130 a and a secondtether aperture 130 a, the first and second tether apertures 130 a, 130b being separated from one another by a bridge portion 134 of the firstbolster device 102. According to such embodiment, at least a portion ofthe suture 110 can extend in a first direction generally away from thesecond bolster device 104 through one of the first and second tetherapertures 130 a, 130 b of the first bolster device 102, and subsequentlypass through the other of the first and second tether apertures 130 a,130 b in a second, opposite direction generally toward the secondbolster device 104. Such passages of the suture 110 through the firstand second tether apertures 130 a, 130 b can be repeated one or moretimes. Additionally, according to certain embodiments, at least aportion of the suture 110 can also be wrapped through the first andsecond tether apertures 130 a, 130 b and around the bridge portion 134of the first bolster device 102. Alternatively, according to otherembodiments, the sutures 110 can pass through one of the first andsecond tether apertures 130 a, 130 b before returning back toward thesecond bolster device 104. Further, according to certain embodiments,the adjustable tether 106 can comprise separate sutures 110 that eachextend through separate ones of the tether apertures 130 a, 130 b, andwhich are joined together by the pre-tied slideable locking knot 116.

According to certain embodiments, the first bolster device 102 can alsoinclude one or more lead suture apertures 132 that extend between thefront side 131 a and the back side 131 b of the first bolster device 102along an aperture axis 136 that can be generally arranged perpendicularto the central axis 124 of the first bolster device 102. The lead sutureapertures 132 can be sized to at least accommodate the passage of a leadsuture 108 (FIG. 1A) that can be used in the displacement of the firstbolster device 102 through a passageway 126 in one or more bones 128 a,128 b, as discussed in greater detail below. According to theillustrated embodiment, the first bolster device 102 is depicted ashaving two lead suture apertures 132. However, according to certainembodiments, the lead suture 108 may extend through only one of the leadsuture apertures 132. Additionally, according to certain embodiments,the first bolster device 102 can have only one lead suture aperture 132through which the lead suture 108 extends. Further, the lead sutureaperture 132 may, or may not, be configured as an aperture that isseparate from the tether apertures 130 a, 130 b such that lead suture108 and the suture 110 of the adjustable tether 106 do, or do not,extend through the same aperture. Further, while FIGS. 1A and 2illustrate the lead suture apertures 132 positioned outside of thetether apertures 130 a, 130 b, according to other embodiments, thetether apertures 130 a, 130 b can be positioned outside of the leadsuture apertures 132 such that the tether apertures 130 a, 130 b areseparated from each other by one or more of the lead suture apertures132.

FIGS. 4A and 4B illustrate front and top perspective views,respectively, of an exemplary embodiment of a second bolster device 104.According to the depicted embodiment, the second bolster device 104includes a wall 138 having an inner portion 140, an outer portion 142, afirst end 144, and a second end 146. According to certain embodiments,the wall 138 extends from the first end 144 to the second end 146 of thewall 138 of the second bolster device 104 along a central axis 148.Further, at least a portion of the wall 138 is configured to provide agenerally elongated body portion 150. The body portion 150 can have avariety of different shapes and sizes, such as, for example, having anoval, square, rectangular, or other non-circular cross-sectional shapes,among other suitable shapes. According to the illustrated embodiment,the body portion 150 is generally cylindrical such that the secondbolster device 104 can have a plug shape. Further, the body portion 150can be sized such that at least a portion of the body portion 150extends into a passageway 126 formed in a bone(s) 128 a, 128 b and/orthrough an aperture 152 in a bone plate 154 (FIGS. 10A and 10B), asdiscussed in greater detail below.

According to certain embodiments, the wall 138 can also include atapered portion 156 in which the wall 138 outwardly extends from theelongated body portion 150 to a plate portion 158 at the first end 144of the wall 138. For example, in the illustrated embodiment, the wall138 can have a size such as, for example, a diameter, along theelongated body portion 150 of the second bolster device 104 that issmaller than a corresponding size, such as a diameter of the plateportion 158 at the first end 144 of the wall 138. According to certainembodiments, at least a portion of the outer portion 142 of the wall 138along the tapered portion 156 and/or plate portion 158 can be sized toprevent the entire second bolster device 104 from being pushed or pulledinto the passageway 126 in one or more bones 128 a, 128 b and/or throughan aperture 152 in a bone plate 154. For example, at least the plateportion 158 can have a size that abuts against an adjacent portion ofbone or an inner wall of an aperture 152 in a bone plate 154 while atleast a portion of the body portion 150 extends into the passageway 126and/or through the aperture in the bone plate 154. Further, the secondbolster device 104 can be sized to prevent the second bolster device104, such as the first end of the second bolster device 104, fromextending beyond an outer surface 153 of the bone plate 154 when thesecond bolster device 104 is operably positioned in the aperture 152 ofthe bone plate 154.

Additionally, according to certain embodiments, at least a portion ofthe elongated body portion 150 can be provided with a shape and/or sizethat assists in the positioning of at least a portion of the bodyportion 150 of the second bolster device 104 in the passageway 126 in abone(s) 128 a, 128 b and/or through an aperture 152 of a bone plate 154.For example, as shown in at least FIG. 4A, according to certainembodiments, the elongated body portion 150 can decrease in size as thewall 138 approaches the second end 146 of the wall 138 of the secondbolster device 104. For example, according to certain embodiments, theelongated body portion 150 can taper inwardly and/or have a chamfer orcurvature as the wall 138 approaches the second end 146, as shown in atleast FIG. 4A.

The first end 144 of the wall 138 of the second bolster device 104 caninclude an inlet 145 in communication with a channel 147 that extendswithin a portion of the second bolster device 104 along the central axis148. For example, according to certain embodiments, the channel 147 canextend from the inlet 145 to an opposite base portion 162 of the channel147. Further, the inlet 145 and the base portion 162 can be separatedfrom each other by a distance that provides the channel 147 with a depththat can accommodate the recessed insertion or embedding of the pre-tiedslideable locking knot 116 of the adjustable tether 106 into/in thechannel 147, as discussed in greater detail below. More specifically,the depth of the channel 147 can allow the pre-tied slideable lockingknot 116 to be placed in the channel 147 in a manner that prevents thepre-tied slideable locking knot 116 from extending beyond the inlet 145,and thereby be recessed or embedded in the channel 147 below at least aportion of the plate portion 158 of the second bolster device 104.

According to certain embodiments, the second bolster device 104 caninclude one or more tether openings 164 and/or recesses 166 that are incommunication with the channel 147. While certain embodiments the secondbolster device 104 illustrated herein are depicted as having two tetheropenings 164, the number of tether openings 164 can vary, including, butnot limited to, having a single tether opening 164 or three or moretether openings 164. According to the embodiment illustrated in FIGS. 4Aand 4B, recesses 166 on opposing sides of the wall 138 can generallyextend upwardly from the second end 146 of the second bolster device 104to a tether opening 164 in the body portion 150 of the wall 138.Moreover, the recesses 166 may be positioned so as to extend from atleast a portion of the second end 146 of the second bolster device 104to different or opposing sides of the channel 147. Further, the recesses166 can extend into the wall 138 at a depth that may permit theadjustable tether 106 to be recessed in the recess 166 such thatadjustable tether 106 does not outwardly protrude from the recess 166beyond the outer portion 142 of the wall 138. Alternatively, therecesses 166 can have a depth to accommodate portions of the adjustabletether being compressed into the recesses 166 when the body portion 150is positioned in a passageway 126. Thus, according to certainembodiments, at least when the bolster system 100 is operably implantedin a patient, the portion of the adjustable tether 106 positioned alongand/or within the recesses 166 can generally be arranged flush with orrecessed below adjacent outer portions 142 of the wall 138 so that therecessed portions of the adjustable tether 106 are not in a positionthat interferes with the placement of at least a portion of the secondbolster device 104 in the passageway of a bone 128 a, 128 b and/or anaperture 152 a home plate 154.

According to the illustrated embodiment, a tether opening 164 can extendthrough opposing sides of the wall 138 along an axis 168 that isarranged generally perpendicular to the central axis 148 of the secondbolster device 104. According to certain embodiments, the tether opening164 may be formed by an intersection of the channel 147 with therecesses 166, and can also define the location of the base portion 162.For example, according to the embodiment shown in FIGS. 4A and 4B, thetether opening 164 can be positioned such that one or more sutures 110of the adjustable tether 106 can extend in a direction that is generallydirected away from the first bolster device 102 along one of tworecesses 166 in the sidewall 138 before extending across a bridgeportion 178 at the base portion 162 of the channel 147, and subsequentlyextend along the other of the two recesses 166 in the sidewall 138 in adirection that is generally directed toward the first bolster device102. Thus, according to such an embodiment, the wall 138 can have athickness between the base portion 162 of the channel 147 and the secondend 146 that can accommodate forces exerted on the bridge portion 178 ofthe second bolster device 104 by the adjustable tether 106.

FIGS. 5A-5C illustrate front, top, and side cross-sectional views,respectively, of an exemplary embodiment of a second bolster device104′. As illustrated in FIGS. 5A-5C, according to the illustratedembodiment, a pair of opposing recesses 166′ extend upwardly generallyfrom the second end 146′ of the wall 138′ to an area at or around thetapered portion 156′ of the wall 138′. Additionally, at least a portionof the recesses 166′ extend to a depth in the wall 138′ that exposes aportion of the channel 147′, or otherwise allows the recesses 166′ to bepositioned in communication with the channel 147′. Further, the recesses166′ and/or base portion 162′ of the channel 147′ can have a rounded orchamfered shape so as to prevent the adjustable tether 106′ fromtransitioning from the recesses 166′ to the bridge portion 178 at thebase portion 162′ along a corner or sharp edge.

FIGS. 6A-6D illustrate front and top views, respectively, of anexemplary embodiment of a second bolster device 104″. As illustrated inFIGS. 6A-6C, the plate portion 158″ can extend from the body portion150″ in a direction that is arranged generally perpendicular to thechannel 147″ and/or the body portion 150″. Further, the plate portion158″ can have an oversized and/or generally elongated shape. Forexample, according to certain embodiments, the plate portion 158″ canhave a length along a first axis 160 (which is shown as shared by line6D-6D in FIG. 6B) of the plate portion 158″ arranged generallyperpendicular to the central axis 148″ that is at least equal to, if notlonger, than a length or width along a second axis 160 (which is shownas shared by line 6C-6C in FIG. 6B) that extends in a direction arrangedgenerally perpendicular to the first axis 160. For example, according tocertain embodiments, the plate portion 158″ can have a length along thefirst axis 160 that is at least about 1 to around 3 times larger, andmore particularly about 1.1 to about 1.5 times larger, than the lengthof the plate portion 158″ along a second axis 160. Additionally,according to certain embodiments the length of the plate portion 158″along the first axis 160 can be approximately one-half inch (½″) whilethe length of the plate portion 158″ along a second axis 160 can beapproximately three eighths of an inch (⅜″).

The elongated shape of the plate portion 158″, and moreover theelongated shape of the plate portion 158″ along at least the first axis160, can, in at least certain circumstances, eliminate the need, whetheractual or perceived, for the inclusion of a bone plate 154 (FIG. 8).Further, by eliminating the use of a bone plate 154 in at least certaincircumstances, the step of drilling holes into bone 128 a, 128 b andimplanting screws into those drilled holes to secure the bone plate 154to bone 128 a can also be eliminated, as well as the associated risksand damage such holes and screws can present to the bone 128 a. Further,such an elongated shape can provide a relatively wide area for the plateportion 158″ to abut and/or press against the adjacent bone 128 a.Moreover, by providing a large area in which the plate portion 158″abuts against the bone 128 a, forces exerted onto the bone 128 a by theplate portion 158″ can be distributed over a larger area. Bydistributing the forces exerted onto the bone 128 a by the plate portion158″ over a larger area, the plate portion 158″ of the present designcan have a decreased likelihood of breaking through the cortex of thebone 128 a.

According to the embodiment depicted in FIGS. 6A-6D, the length of theplate portion 158″ along the first axis 160 can be around the same orgreater than the overall length of the second bolster device 104″ alongthe central axis 148″. For example, according to certain embodiments,the length of the plate portion 158″ along the first axis 160 can beapproximately 1.1 to approximately 3 times greater than the overalllength of the second bolster device 104″ along the central axis 148″. Asanother example, the length of the plate portion 158″ along the firstaxis 160 can be approximately one-half inch (½″), which can beapproximately 1.5 to 2 times larger than the overall length of thesecond bolster device 104″ from a top surface 170 of the plate portion158″ to the second end 146″ of the wall 138″.

According to certain embodiments, the plate portion 158″ can be curvedin at least one direction. The location, orientation, degree, and numberof curvatures can be based on a variety of different factors, includingthe ability of at least a portion of the bottom surface 172 of the plateportion 158″ to be shaped to generally conform to the shape and/or sizeof the portion of the bone 128 a against which at least a portion of thebottom surface 172 can abut. For example, according to the illustratedembodiment, the plate portion 158″, including the top and bottomsurfaces 170, 172, can be curved between first and second sidewalls 174a, 174 b that are on opposite sides of the first axis 160. According tosuch an embodiment, the apex of the curvature can extend around thefirst axis 160. Further, such a curvature along the bottom surface 172of the plate portion 158″ can, in at least certain embodiments,facilitate the ability of the bottom surface 172 of the plate portion158″ to be positioned in relatively flush contact with a fibular cortex.

The inlet of the second bolster device 104″ can extend through the plateportion 158″ such that at least a portion of the adjustable tether 106can at least initially extend outside of the channel 147″ and beyond theplate portion 158″ through the inlet 145″. Further, in the illustratedembodiment, the plate portion 158″ can include a chamfered or inclinedinner wall 176 that can facilitate the passage of at least a portion ofthe adjustable tether 106 such as, for example, the pre-tied slideablelocking knot 116, into the channel 147″. Further, the body portion 150″of the second bolster device 104″ shown in at least FIGS. 6A, 6C and 6Dcan be configured similar to any of the body portions 150, 150′ shown inFIGS. 4A-5C, or can have a variety of other shaped body portions.

FIGS. 7A-7C illustrate another exemplary embodiment of a second bolsterdevice 104 a having one or more retention tabs 105 that outwardlyproject from the outer portion 142 of the wall 138. The retention tabs105 can have a variety of shapes and sizes. For example, according tothe illustrated embodiment, as shown in FIG. 7A, the retention tab 105has a generally planar profile and outwardly extends from the wall 138in a direction that is arranged perpendicular to the central axis 148,148′, 148″ (FIGS. 4A, 5C and 6C). Further, as shown in FIGS. 7B and 7C,according to certain embodiments, the retention tab 105 can have agenerally round or curved shape. However, it should be understood thatthe retention tab 105 can have a variety of other shapes or profiles.

The retention tab 105 is positioned and shaped to engage one or morelocking lobes or teeth 200 in an aperture 152 of a bone plate 154 (FIGS.8A and 8B) in a manner that may assist in retaining the second bolsterdevice 104 a in locking engagement with the locking teeth 200. Forexample, according to certain embodiments, the retention tab(s) 105 maybe sized to engage a side of the locking tooth/teeth 200 that facestoward the bone of the patient. Moreover, the retention tab 105 can bepositioned and sized relative to at least the locking teeth 200 such aswhen the second bolster device 104 a is rotated into an aperture of thebone plate 154, the retention tab 105 can be rotated to a position belowthe superior plate surface such that the retention tab 105 is generallypositioned between the bone and the adjacent locking tooth/teeth 200.For example, according to certain embodiments, the retention tab 105 canbe sized to be at displaced through a space or gap between adjacentlocking teeth 200 as the second bolster device 104 a is rotated relativeto the aperture 152 so that the retention tab 105 is positioned beneathat least one locking tooth 200.

With the retention tab 105 at such a position, the locking tooth 200 maybe positioned to engage with the retention tab 105 in a manner in whichthe locking tooth/teeth 200 provides an interference or barrier againstat least subsequent axial displacement of the second bolster device 104a out of the associated aperture 152. Such engagement between theretention tab 105 and the one or more locking lobes or teeth 200 in theaperture 152 of the bone plate 154 can, for example, at least assist inretaining the second bolster device 104 a in a position relative to atleast the bone plate 154, including, for example, in instances where thetension on the fractured bones that is provided by use of the bone plate154 and associated bone screws changes. For example, in at least certaininstances in which tension used to hold a position of bones or fracturesis reduced, engagement between the retention tab 105 and the one or morelocking lobes or teeth 200 can at least assist in preventing the secondbolster device 104 a from being displaced away from, or at leastpartially popping out of, the bone plate 154. Additionally, theretention tab 105 and/or locking tooth/teeth 200 may be positioned suchthat the retention tab 105 is in pressing engagement with the lockingtooth/teeth 200, or another force is asserted between the retention tab105 and locking tooth/teeth 200 that prevents at least rotationaldisplacement of the second bolster device 104 a relative to the boneplate 154. For example, according to the embodiment illustrated in FIGS.7A-7C, the retention tab 105 is positioned at a distance below the plateportion 158 at the first end 144 of the second bolster device 104 a at alocation in which the tab engages at least a portion of one or more ofthe locking teeth 200. For example, the retention tab 105 can bepositioned about 0.015 millimeters (mm) to about 0.020 millimeters (mm)below the proximately adjacent bottom surface of the plate portion 158of the second bolster device 104 a.

Additionally the retention tab 105 can outwardly extend to a distancethat is greater than a similar outward distance of other relativelyadjacent portions of the plate portion 158. For example, according tocertain embodiments, the tab portion 105 can outwardly extendapproximately 0.09 millimeters (mm) further than the correspondingoutward distance of the proximately adjacent portion of the plateportion 158. Further, to at least facilitate such locking engagement, atleast one of the retention tabs 105 and the locking tooth/teeth 200 canbe configured to be deformed, deflected, or otherwise bent when in apressed engagement with the other of the retention tab 105 and thelocking tooth/teeth 200. For example, according to certain embodiments,the retention tab 105 can have a thickness of approximately 0.020millimeters (mm).

FIG. 8 illustrates a side view of an exemplary embodiment of a secondbolster device 104 b having a threaded member 107. According to theillustrated embodiment, the threaded member 107 is configured as anexternal thread structured to engage one or more of the locking teeth200 of the bone plate 154 in a manner that at least assists inmaintaining the second bolster device 104 b in locking engagement withthe bone plate 154. Moreover, the thread member 107 can engage one ormore of the locking teeth 200 of the bone plate 154 in a manner that atleast resists removal of the second bolster device 104 b from the boneplate 154. For example, according to the illustrated embodiment, atleast a portion of the previously discussed plate portion 158 caninclude, or be replaced by, the threaded member 107. As the secondbolster device 104 b is rotated within the aperture 152 of the boneplate 154 and axially displaced toward the bone, at least a portion ofthe threaded member 107 may pass through a gap or space between adjacentlocking teeth 200 of the bone plate 154 and proceed to a position inwhich at least a portion of the threaded member 107 below the superiorsurface of the bone plate 154 and between at least one locking tooth 200and the bone. With at least a portion of the threaded member 107positioned below at least one locking tooth 200, the locking tooth/teeth200 provides an interference or barrier against at least subsequentaxial displacement of the second bolster device 104 b out of theassociated aperture 152. Additionally, at least a portion of thethreaded member 107 and/or locking tooth/teeth 200 may be positionedsuch that the threaded member 107 is in pressing engagement with thelocking tooth/teeth 200, or another force is provided between thethreaded member 107 and locking tooth/teeth 200, that prevents at leastrotational displacement of the second bolster device 104 b relative tothe bone plate 154.

Additionally, similar to the engagement between the retention tab 105and the one or more locking lobes or teeth 200 in the aperture 152 ofthe bone plate 154, the engagement between the threaded member 107 andthe one or more locking lobes or teeth 200 in the aperture 152 can alsoat least assist in retaining the second bolster device 104 b in positionrelative to at least the bone plate 154 including, for example, ininstances in which the tension on the fractured bones that is providedby the use of the bone plate 154 and associated bone screw changes. Forexample, engagement between the threaded member 107 and the one or morelocking lobes or teeth 200 can at least assist in preventing the secondbolster device 104 b from being displaced away from, or at leastpartially popping out of, the bone plate 154.

As shown in FIGS. 7A-8, according to certain embodiments, the secondbolster device 104 a, 104 b can also include one or more driver surfaces109 that are shaped to facilitate engagement between the second bolsterdevice 104 a, 104 b and a driver 300 (FIGS. 15C and 15D). For example,according to the illustrated embodiments, the driver surfaces 109 can bepositioned to form one or more recesses 111 in second bolster device 104a, 104 b that can each receive an arm 302 a, 302 b of the driver 300.According to the exemplary embodiment shown in FIGS. 15C and 15D, thearms 302 a, 302 b of the driver 300 can extend from a shaft 304 that iscoupled to a handle 306. The arms 302 a, 302 b can be separated fromeach other by a gap 308. The gap 308 and/or recesses 111 may be sized toaccommodate at least a portion of the arms 302 a, 302 b being receivedin a corresponding recess 111. Further, the gap 308 can extend along alength of the shaft 304 so as to accommodate at least a portion of thetether 110 of the bolster system 100 being received within the gap whilethe driver 300 is operably engaged with the second bolster device 104 a,104 b. With the driver 300 is operably engaged with the second bolsterdevice 104 a, 104 b, and with the arms 302 a, 302 b each positioned in arecess 111 of the second bolster device 104 a, 104 b, a user may rotatethe driver 306 such as by gripping the handle 306. Depending on thedirection of rotation, such rotation of the driver 300 will betranslated to the second bolster device 104 a, 104 b via the arms 302 a,302 b engaging one or more of the driver surfaces 109. Further, suchrotation of the second bolster device 104 a, 104 b can, when the secondbolster device 104 a, 104 b is being inserted into an aperture 152 ofthe bone plate 154 (FIG. 15C), facilitate the retention tab 105 orthreaded member 107 being rotated to a position in which the retentiontab 105 or threaded member 107 is positioned between one or more lockingteeth 200 and an adjacent bone 128 a, thereby at least assisting inlocking the position of the second bolster device 104 a, 104 b relativeto the bone plate 154, as discussed in detail above.

While the retention tab 105, the threaded member 107, the driversurfaces 109, and the recesses 111 are discussed and illustrated inconnection with certain exemplary second bolster devices 104 a, 104 b,such features can also be incorporated into other bolster devicesincluding, for example, the second bolster devices 104, 104′, 104″illustrated in FIGS. 1A-6D, among other devices. Similarly, the featuresdiscussed herein with respect to the second bolster devices 104, 104′,104″ illustrated in FIGS. 1A-6D can be incorporated into the secondbolster devices 104 a, 104 b shown in FIGS. 7A-8, among other devices.

Additionally, the second bolster device 104, 104′, 104″, 104 a, 104 bcan be secured within the bone plate 154 at a variety of differentangles while still being recessed within at least the bone plate 154.Such variability can provide a degree of patient-to-patient variability.For example, according to certain embodiments, the second bolster device104, 104′, 104″, 104 a, 104 b can have a size and/or shape that canaccommodate the second bolster device 104, 104′, 104″, 104 a, 104 bhaving up to 15 degrees of freedom relative to at least the aperture 152of the bone plate 154. Further, the number of locking teeth 200 for anaperture 152 can vary and can include, for example, five or six lockingteeth 200, among other numbers of locking teeth 200.

FIG. 9 illustrates an example of a second bolster device 104″ secured toan adjustable tether 106 prior to implantation in a patient. As shown,the pre-tied slideable locking knot 116 is positioned or embedded withinthe channel 147″ such that the pre-tied slideable locking knot 116 ispositioned adjacent to the bridge portion 178 of the second bolsterdevice 104 at the base portion 162 of the channel 147″. Accordingly, aspreviously discussed, the channel 147″ can have one or more sizes suchas, for example, a diameter and depth that accommodate placement of thepre-tied slideable locking knot 116 in the channel 147″. Additionally,the channel 147″ can also have a depth that prevents ends 180 of theadjustable tether 106 that extend from beyond the pre-tied slideablelocking knot 116 from extending beyond the inlet 145 of the secondbolster device 104, 104′, 104″ when the bolster system 100 is implantedin a patient. Moreover, at least a portion of the ends 180 of theadjustable tether 106 can be removed or cut when the bolster system 100is operably positioned or secured to a patient. Thus, the channel 147″can have a depth that permits the remaining portions of the cut ends 180that extend from the pre-tied slideable locking knot 116 from extendingoutside of the channel 147″, thereby at least attempting to prevent theends 180 from engaging the patient in a manner that can result inirritation to the patient.

FIG. 11 illustrates a drill bit 182 for use with the bolster system 100.According to certain embodiments, the drill bit 182 can include a firstsection 184 a and a second section 184 b, the first section 184 a havinga size such as, for example, a diameter that is larger than acorresponding size of the second section 184 b. According to theillustrated embodiment, the first section 184 a can extend from a firstend 186 of the drill bit 182 and can include at least the cutting edgeand flutes of the drill bit 182. For example, according to certainembodiments, the first section 184 a of the drill bit 182 can providethe cutting surface and flute for a 3.5 millimeter drill bit. Further,according to certain embodiments, the first section 184 a can include afirst shank portion 188 a and the second portion 184 b can include asecond shank portion 188 b, with the first shank portion 188 a having anouter size that is larger than a corresponding outer size of the secondshank portion 188 b. The portion of the second shank portion 188 b thatis in proximity to the second end 190 of the drill bit 182 can includean eyelet 192 that extends through at least a portion of, or extendsfrom, the second shank portion 188 b. For example, the eyelet 192 canextend from the second shank portion 188 b and have an outer size suchas, for example, a diameter which is smaller than a corresponding sizeof the second shank portion 188 b. The eyelet 192 is configured toprovide an opening through which the lead suture 108 can extend in amanner that can accommodate the lead suture being coupled to the drillbit 182. For example, the lead suture 108 can be tied to itself suchthat the lead suture 108 forms a generally continuous loop that extendsthrough the eyelet 192, as well as through one or more tether apertures130 a, 130 b in the first bolster device 102.

FIG. 12 illustrates use of an exemplary drill guide 194 to guide thelocation of drilling by the drill bit 182 through one or more bones 128a, 128 b in connection with forming a passageway 126 through the bone(s)128 a, 128 b. According to the illustrated embodiment, prior to drillingof the passageway 126, the bone plate 154 (shown in FIGS. 10A and 10B)can be secured to an exterior surface of a bone 128 a through theinsertion of one or more fixation devices 196, such as screws, throughapertures 152 in the bone plate 154 and into drilled holes in the bore128 a. According to such embodiment, as previously discussed, thebolster system 100, including at least certain embodiments of the secondbolster device 104, 104′, 104 a, 104 b, among others, can be receivedwithin an aperture 152 in the bone plate 154. However, according toother embodiments, the bolster system 100 can be utilized in a patientwithout the inclusion of a bone plate 154.

The drill guide 194 can be configured to be used with, or without, aseparate drill clamp, and can be positioned along the bone(s) 128 a, 128b at a location in which drill bit 182, when operably coupled to thedrill guide 194, will drill or otherwise form the passageway 126 along apre-determined trajectory and/or at pre-determined location within thebone(s) 128 a, 128 b. The drill bit 182 can also be, if not already,coupled to a drill (not shown) such that operation of the drill rotatesthe drill bit 182 in a manner in which the drill bit 182 can cut intothe bone(s) 128 a, 128 b to form the passageway 126. Referencing FIG.12, according to the illustrated embodiment, the drill bit 182 can beoperated by operation of the drill to cut through the four cortices ofthe fibula 128 a and tibia 128 b

The passageway 126 can be provided with a variety of different shapesand/or sizes. For example, according to certain embodiments, thepassageway 126 can generally have a circular cross-sectional shape thatis provided by the drill bit 182. According to other embodiments, thesize and/or shape of the passageway 126 can be altered via the use ofone or more other cutting or shaping instruments or components. Forexample, FIGS. 13A and 13B illustrate a cutting guide that can be usedwith at least the drill bit 182 b to provide the passageway 126 in thebone 128 a, 128 b with a non-round cross-sectional shape such as, forexample, an oval shape. For example, according to certain embodiments,the cutting guide can include a first drill bit 182 a (FIG. 13A) thathas a vertical slot 198 and which is used to drill a first hole in thebone 128 a, 128 b that has a generally circular cross-sectional shape. Asecond drill bit 182 b (FIG. 13B) can then be positioned to extend alongthe slot 198 of the first drill bit 182 a as the second drill bit 182 bremoves additional bone material from the bone(s) 128 a, 128 b at alocation that at least extends from one side of the hole that was formedin the bone(s) 128 a, 128 b by the first drill bit 182 a. Thecombination of holes formed by the first and second drill bits 182 a,182 b can thereby form a passageway 126 having a generally elongatedand/or oval shape. Such non-round shapes can be particularly suited forforming holes which are large enough to accommodate the insertion of atleast a portion of the body portion 150, 150′, 150″ of the secondbolster device 104, 104′, 104″, but which are also constrained by thesize of the aperture 152 of a bone plate 154 such as, for example, at alocation between locking teeth 200 in the aperture 152 of the bone plate154 (FIGS. 10A and 10B). Alternatively, rather than utilizing first andsecond drill bits 182 a, 182 b, a s ingle drill bit having a shortcutting surface and flat surfaces that can fit between the locking teeth200 in the aperture 152 of the bone plate 154 can be used.

FIGS. 14A and 14B illustrate another shaping apparatus 202 structured toform a cross-sectional shape and/or size of a passageway through one ormore bones 128 a, 128 b. According to such embodiments, the shapingapparatus 202 includes a drill bit 182″ that drills through the corticesof one or more of the bones 128 a, 128 b. The shaping apparatus 202 canfurther include a chisel 204 that can slide over the drill bit 182″ orotherwise be displaced with the drill bit 182″, and through the holeformed by the drill bit 182″. According to such an embodiment, after thedrill bit 182″ has established a hole through the bones 128 a, 128 b,the chisel 204 can pass along or with the drill bit 182″ and through theaperture 152 in the bone plate 154. For example, according to certainembodiments, the chisel 204, which can have an ovular cross-sectionalshape, can be displaced along the drill bit 182″ in a direction that isgenerally tangential to locking teeth 200 in the aperture 152 of thebone plate 154. According to such an embodiment, the drill bit 182″ canguide displacement of the chisel 204 through the hole formed by thedrill bit 182″ as the chisel 204 is tapped with an impact device suchas, for example, a hammer or another impact device, and thereby forminga generally oval, or non-round, shaped passageway 126.

With the passageway formed, the drill bit 182, 182 a, 182 b, 182″ can bede-coupled from the drill, thereby exposing the eyelet 192. The leadsuture 108, which can already be coupled to the first bolster device102, can then be coupled to the drill bit 182, 182 a, 182 b, 182″ suchthat, as the drill bit 182, 182 a, 182 b, 182″ is pulled through thepassageway 126, at least a portion of the lead suture 108 can also passthrough the passageway 126. Referring to FIG. 13, with the lead suture108 exposed through one side of the passageway 126, the first bolsterdevice 102 can be oriented, if not already, at a first orientation sothat the first bolster device 102 is oriented to pass into a first side206 a of and through the passageway 126. The first bolster device 102can then be displaced through the passageway 126 by a pulling force onthe drill bit 182, 182 a, 182 b, 182″ and/or the lead suture 108. Whenthe first bolster device 102 passes out of a second side 206 b of thepassageway 126, the first bolster device 102 can be manipulated to, ifnot already, in a second orientation that can abut the back side 131 bof the first bolster device 102 against a bone 128 b in a manner thatprevents the return passage of the first bolster device 102 through thepassageway, sa shown in FIG. 14.

As previously mentioned, according to certain embodiments, the pre-tiedslideable locking knot 116 can be formed at least before the lead suture108 and/or first bolster device 102 enters the passageway 126.Additionally, according to certain embodiments, the pre-tied slideablelocking knot 116 can be pre-formed such as that the pre-tied slideablelocking knot 116 is, and remains, embedded in the second bolster device104, 104′, 104″ including, for example, embedded in the second bolsterdevice 104, 104′, 104″ prior to the first bolster device 102 enteringinto the passageway 126. Thus, when the first bolster device 102 ispositioned and oriented for operable abutment against a portion of theadjacent bone 128 b, one or more ends 180 of the adjustable tether 106can be pulled so as to at least axially displace the pre-tied slideablelocking knot 116 from a first position to a second position so that thebolster system 100 exerts tension on the fibula and tibia in a mannerthat can at least assist in the repair of the tibiofibular joint.Further, according to certain embodiments in which the pre-tiedslideable locking knot 116 is embedded in the second bolster device 104,104′, 104″, such displacement of the pre-tied slideable locking knot 116can be relative to the adjustable tether 106, as the pre-tied slideablelocking knot 116 can generally be at a relatively static positionrelative to the second bolster device 104, 104′, 104″ and/or subjectedto minimal axial displacement generally in a direction the along thecentral axis 148, 148′, 148″ within the second bolster device 104, 104′,104″.

Alternatively, according to certain embodiments, when tightened, thepre-tied slideable locking knot 116 can be axially displaced from afirst position at which the pre-tied slideable locking knot 116, or aportion of the pre-tied slideable locking knot 116, is positionedoutside of the second bolster device 104, 104′, 104″, to a secondposition in which the pre-tied slideable locking knot 116 is recessedinside of the second bolster device 104, 104′, 104″. Additionally,according to certain embodiments, the second bolster device 104, 104′,104″ can be positioned such that at least a portion of the secondbolster device 104, 104′, 104″ extends into the passageway 126 and/oraperture 152 of the bone plate 154 prior to displacement of the pre-tiedslideable locking knot 116 from the first position to the secondposition. Further, when at the second position, the pre-tied slideablelocking knot 116 can be positioned or embedded in the channel 147, 147′,147″ of the second bolster device 104, 104′, 104″ at a location in whichthe pre-tied slideable locking knot 116 abuts against or is otherwise inclose proximity to the bridge portion 178 at the base of the channel147, 147′, 147″ of the second bolster device 104, 104′, 104″. Further,the pre-tied slideable locking knot 116 is configured to prevent thepre-tied slideable locking knot 116 from returning from the secondposition to the first position along the adjustable tether 106 so as toat least assist the bolster system 100 in maintaining tension on fibulaand tibia.

While the preceding examples and figures are discussed with respect tosyndemosis repairs, it should be understood that the bolster system 100can be utilized for repairs to a variety of other joints and/or bones.For example, as illustrated by FIGS. 16A-16C, the bolster system 100 canextend through adjacent metacarpal bones 208 a, 208 b of a wrist or band210. According to the illustrated example, a passageway can be drilledor otherwise formed through the first and second metacarpal bones 108 a,208 b that is sized to accommodate the passage of a first bolster device102 when the first bolster device 102 is in a first orientation. Again,the adjustable tether 106 can be operably secured to the first device102 prior to insertion of the first device 102 into the drilled orotherwise formed passageway in the first and second metacarpal bones 208a, 208 b. Further, the second bolster device 104″′ can be operablysecured to the adjustable tether 106 by the pre-tied slideable lockingknot 116 prior to insertion of the first bolster device 102 into thefirst and second metacarpal bones 208 a, 208 b. Moreover, according tocertain embodiments, the pre-tied slideable locking knot 116 can beformed such that the pre-tied slideable locking knot 116 is embeddedwithin the second bolster device 102, wherein the pre-tied slideablelocking knot 116 can remain at least before, during, and after the firstbolster device 102 has been inserted into and through the passageway inthe first and second metacarpal bones 208 a, 208 b, as well as beforeand during the displacement of the pre-tied slideable locking knot 116from the first position to the second position relative to at least theadjustable tether 106. Accordingly, similar to the previously discussedexamples, upon exiting the passageway of the first metacarpal bone 208a, the first bolster device 102 can be manipulated to a second positionthat prevents the first bolster device 102 from passing back through thepassageway. With the first bolster device 102 in the second position,the first and/or second ends 112, 114 of the adjustable tether 106 canbe pulled, thereby reducing a length of the adjustable tether 106 thatextends between at least the pre-tied slideable locking knot 116 and thefirst bolster device 102, and thereby displacing the slideable lockingknot 116 from the first position to the second position relative to atleast the adjustable tether 106.

FIGS. 17A and 17B illustrate an additional, non-limiting use of thebolster system 100 in the repair of joints and/or bones. Moreover, asshown in FIGS. 17A and 17B, the bolster system 100 can also be used inassociation with the repair of a shoulder such as, for example, repairof acromioclavicular (AC) joints 212. As shown, in at least certainsituations, implantation of the bolster system 100 can include passingthe first bolster device 102 at a first orientation through a passagewaydrilled or otherwise formed in the clavicle 214 and the acromion 216.With the first bolster device 102 extending out of the passageway andbeyond the acromion 216, the first bolster device 102 can be manipulatedto a second orientation that prevents the first bolster device 102 frompassing back through the passageway. While a variety of different shapedand sized first bolster devices 102 can be used with the bolster system100, according to certain embodiments, relatively small bolster devices102 may be used such as, for example, bolster devices 102 having a widthof about 3.5 millimeters (mm). The first and/or second ends 112, 114 ofthe adjustable tether 106 can be pulled, thereby reducing a length ofthe adjustable tether 106 that extends between at least the pre-tiedslideable locking knot 116 and the first bolster device 102, and therebydisplacing the slideable locking knot 116 from the first position to thesecond position relative to at least the adjustable tether 106 such thatpre-tied slideable locking knot 116 is tightened at the second position.Moreover, the first and/or second ends 112, 114 of the adjustable tether106 can be pulled such that the pre-tied slideable locking knot 116 istightened in a manner that prevents the length of the adjustable tether106 between the first bolster device 102 and at least the pre-tiedslideable locking knot 116 and/or the second bolster device 104″″ fromsubsequently increasing.

While the invention has been described in connection with what ispresently considered to be the most practical and preferred embodiment,it is to be understood that the invention is not to be limited to thedisclosed embodiment(s), but on the contrary, is intended to covervarious modifications and equivalent arrangements included within thespirit and scope of the appended claims, which scope is to be accordedthe broadest interpretation so as to encompass all such modificationsand equivalent structures as permitted under the law.

Furthermore it should be understood that while the use of the wordpreferable, preferably, or preferred in the description above indicatesthat feature so described can be more desirable, it nonetheless may notbe necessary and any embodiment lacking the same may be contemplated aswithin the scope of the invention, that scope being defined by theclaims that follow. In reading the claims it is intended that when wordssuch as “a,” “an,” “at least one” and “at least a portion” are used,there is no intention to limit the claim to only one item unlessspecifically stated to the contrary in the claim. Further, when thelanguage “at least a portion” and/or “a portion” is used the item mayinclude a portion and/or the entire item unless specifically stated tothe contrary.

1. An apparatus, comprising: an adjustable tether having a pre-tied knotslideably displaceable in one direction from a first axial position to asecond axial position; a first bolster device coupled to the adjustabletether, the first bolster device having a width and a length sized toaccommodate passage of the first bolster device through a passageway ina first orientation of the first bolster device and sized to preventpassage through the passageway when the first bolster device is in asecond orientation, wherein the pre-tied knot is tied prior to insertionof the first bolster device into the passageway; and a second bolsterdevice coupled to the adjustable tether, the second bolster devicepositioned between the pre-tied knot and the first bolster device, thesecond bolster device having a channel that extends through at least aportion of the second bolster device and sized to receive placement ofthe pre-tied knot, wherein an axial distance between the pre-tied knotand the first bolster device is reduced by slideable displacement of thepre-tied knot from the first axial position to the second axialposition.
 2. The apparatus of claim 1, wherein the pre-tied knot isembedded within the second bolster device prior to insertion of thefirst bolster device into the passageway.
 3. The apparatus of claim 1,wherein the second bolster device includes an external threaded member.4. The apparatus of claim 1, wherein the second bolster device includesone or more retention tabs that outwardly extend from a wall of thesecond bolster device and structured to operably engage one or morelocking teeth of a bone plate.
 5. The apparatus of claim 1, wherein thesecond bolster device includes one or more recesses sized to matinglyengage a driver member.
 6. The apparatus of claim 5, further comprisingthe driver member, the driver member having a shaft and a handle, theshaft having a first arm and a second arm, the first and second armsseparated by a gap and each sized to be received in a recess of the oneor more recesses.
 7. The apparatus of claim 6, wherein the gap is sizedto receive a portion of the adjustable tether when the first and secondarms are each received in the one or more recesses.
 8. The apparatus ofclaim 5, wherein the one or more recesses extend to a first end of thesecond bolster device and are bordered by one or more driver surfacesalong an outer surface of the second bolster device.
 9. The apparatus ofclaim 1, wherein the second bolster device includes a plate portion anda body portion, the plate portion structured to abut against an exteriorsurface of a bone, and wherein the plate portion has a height that islarger than the largest size of a portion of the body portion that isstructured for placement in the passageway.
 10. The apparatus of claim1, further comprising a drill bit and a lead suture, the drill bithaving an eyelet sized to receive a portion of the lead suture, the leadsuture having a length sized to extend at least from a lead aperture inthe first bolster device to the eyelet, the drill bit structured to formthe passageway in the one or more bones.
 11. The apparatus of claim 10,wherein the drill bit has a cutting portion and a shank portion, thecutting portion having an outer diameter that is larger than an outerdiameter of the shank portion, and wherein the eyelet extends into theshank portion of the drill bit.
 12. An apparatus, comprising: a firstbolster device and a second bolster device, the second bolster devicehaving a plate portion and a body portion, the body portion including achannel that extends through the plate portion; an adjustable tetherextending through one or more apertures of the first bolster device andthe body portion of the second bolster device, the adjustable tetherhaving a pre-tied slideable locking knot embedded within the secondbolster device, the pre-tied slideable locking knot displaceable in onedirection from a first position to a second position and along theadjustable tether; and wherein the adjustable tether has a first lengthbetween the first and second bolster devices when the pre-tied slideablelocking knot is at the first position, wherein the adjustable tether hasa second length when the pre-tied slideable locking knot is at thesecond position, the second length being smaller than the first length,and wherein the pre-tied slideable locking knot is at the first positionprior to insertion of the first bolster device into a passageway. 13.The apparatus of claim 12, wherein the plate portion is structured toabut against an exterior surface of one or more bones.
 14. The apparatusof claim 12, wherein the second bolster device includes an externalthreaded member structured to engage one or more locking teeth of a boneplate.
 15. The apparatus of claim 12, wherein the second bolster deviceincludes one or more retention tabs that outwardly extend from a wall ofthe second bolster device and structured to operably engage one or morelocking teeth of a bone plate.
 16. The apparatus of claim 14, whereinthe second bolster device includes one or more recesses sized totranslate a rotation force from a driver member to rotationaldisplacement of the second bolster device.
 17. A method, comprising:forming, with at least a drill bit, a passageway through one or morebones; disconnecting the drill bit from a drill; coupling a lead sutureto the disconnected drill bit, the lead suture coupled to a firstbolster device, the first bolster device coupled to a second bolsterdevice by an adjustable tether having a pre-tied knot at a firstposition along the adjustable tether within the second bolster device;displacing, via displacement of the drill bit, the lead suture and thefirst bolster device through the passageway; and sliding, afterdisplacing the first bolster device through the passageway, the pre-tiedknot along the adjustable tether from the first position to a secondposition, a length of the adjustable tether between the first bolsterdevice and the pre-tied knot being reduced as the pre-tied knot is slidfrom the first position to the second position.
 18. The method of claim17, wherein the sliding of the pre-tied knot along the adjustable tetherincludes embedding the pre-tied knot within the second bolster devicebeneath an inlet of the second bolster device.
 19. The method of claim17, further comprising rotatably displacing either at least a portion ofa threaded member or one or more retention tabs of the second bolsterdevice below one or more locking teeth of a bone plate secured to theone or more bones.
 20. The method of claim 19, further comprisingpositioning a portion of a driver into one or more recesses in thesecond bolster device, and rotatably displacing the second bolsterdevice via rotation of the driver.